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New York runs its small group market differently: it covers employers up to 100 employees, rates are community rated, and stop-loss can’t be sold to small groups. Here is what that means for your options.
In New York, small group means 1 to 100 employees. Plans are guaranteed issue and community rated, so your price doesn’t depend on your employees’ ages or health history.
Because New York bars selling stop-loss coverage to small groups, level funding generally isn’t an option up to 100 employees. Your real choices are fully insured plans, plan design and contribution strategy, and an ICHRA for some or all employee classes. Past 100, the large group market opens up.
| New York | Most states we serve | |
|---|---|---|
| Small group size | 1 to 100 employees | 1 to 50 employees |
| Small group pricing | Community rated: no age rating | Adjusted community rating: age, location, tier and (where allowed) tobacco |
| Level funding for small groups | Generally not available (stop-loss can’t be sold to small groups) | Often available from about 5 to 10 enrolled |
| Short-term plans | Prohibited | Allowed in many states, with limits |
| Continuation for employers under 20 | State continuation, up to 36 months on insured plans | Varies by state |
A 90-person company is still small group in New York. That means guaranteed issue and community rating, but also no stop-loss and no level funding until you pass 100.
With community-rated pricing, the levers are plan lineup, deductibles and copays, HSA-eligible options and how much you contribute to each tier.
For hourly, part-time or multi-location teams, an ICHRA by employee class can sit beside a group plan or replace it. CMS now calls it a CHOICE Arrangement.
Federal COBRA generally applies at 20 or more employees; below that, New York’s state continuation law applies to insured plans, with up to 36 months of coverage.
See the small group hub, the large group hub for 101+, New York individual and family coverage, and the ICHRA guide.
Yes. New York’s small group market covers employers with 1 to 100 employees, unlike most states, where it stops at 50.
Generally not. New York law bars selling stop-loss coverage to small groups, and level-funded plans depend on stop-loss, so level funding usually isn’t available to groups of 100 or fewer.
Yes. Employers with fewer than 20 employees, which federal COBRA doesn’t cover, are subject to New York’s state continuation law on insured plans, which allows up to 36 months. Employees of larger employers get federal COBRA, and New York extends insured coverage to a combined 36 months.
Yes. An ICHRA, which CMS now calls a CHOICE Arrangement, works in New York, and employees buy individual plans through NY State of Health or directly from a carrier.
At 101 employees and up you are in the large group market, where funding options such as level funding and self-funding with stop-loss open up. See large group benefits.
Sources: New York DFS: small group expansion to 1-100 employees; New York DFS: small group stop-loss study; New York DFS: state continuation coverage extension to 36 months; U.S. Department of Labor: COBRA; CMS: CHOICE Arrangements, previously known as ICHRAs.
Send us your census or your renewal. We compare the plans and designs available to your New York group, side by side.
Quotes are non-binding and based on the information you provide.